Digital health interventions for children and adolescents with respiratory diseases: an overview of systematic reviews

Abstract Background Digital health interventions for pediatric respiratory disease have been evaluated in overlapping systematic reviews with heterogeneous populations, technologies and outcomes. We examined the pediatric evidence, review credibility and study overlap to determine which clinical conclusions are supported and where important uncertainties remain. Methods We searched PubMed, Embase, the Cochrane Library and CINAHL from inception to 8 June 2026 for systematic reviews of digital respiratory management or rehabilitation in participants aged ≤ 18 years. For mixed populations, we extracted only separately identifiable pediatric respiratory findings. We consolidated linked primary reports, assessed reviews using ROBIS and AMSTAR 2, and quantified overlap using the corrected covered area (CCA). We synthesized findings by disease, study design and outcome without conducting a new meta-analysis or de novo outcome-level GRADE assessment. Results Fifteen reviews contributed 83 distinct study units and 143 review–study links (CCA 5.16%): 69 asthma, 12 cystic fibrosis (CF), one non-CF bronchiectasis and one primary ciliary dyskinesia study. ROBIS indicated low risk of bias in eight reviews, high risk in five and unclear risk in two. AMSTAR 2 indicated low confidence in one review and critically low confidence in 14. Asthma findings varied: one pediatric control meta-analysis showed no clear benefit (standardized mean difference 0.04, 95% confidence interval − 0.20 to 0.28), whereas another reported improved control with substantial heterogeneity. Pediatric quality-of-life syntheses showed no clear advantage. CF evidence included small, short-term exercise studies and feasibility reports. Safety and contemporary cost-effectiveness were insufficiently characterized. Conclusions Current review evidence is insufficient to support routine addition of digital interventions across pediatric respiratory care. Some asthma outcomes appear favorable, but effects vary by intervention and outcome; CF evidence is limited and other conditions remain evidence gaps. Overlap, review limitations and incomplete safety and economic data preclude firm practice recommendations. Adequately powered multicentre trials with long-term clinical, safety and economic outcomes are needed. Registration PROSPERO CRD420261416488.